• Title/Summary/Keyword: cause analysis

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Role of Invasive Procedures in the Diagnosis and Management of Pulmonary Infiltrates in Patients with Leukemia (백혈병 환자에서 발생한 폐침윤의 진단 및 치료에 있어 침습적 검사의 역할)

  • Kang, Soo-Jung;Park, Sang-Joon;An, Chang-Hyeok;Ahn, Jong-Woon;Kim, Ho-Cheol;Lim, Si-Young;Suh, Gee-Young;Kim, Ho-Joong;Kwon, O-Jung;Lee, Hong-Ghi;Rhee, Chong-H.;Chung, Man-Pyo
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.4
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    • pp.448-463
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    • 2000
  • Background : Pulmonary infiltrate is a frequent cause of morbidity and mortality in patients with leukemia. It is often hard to obtain a reliable diagnosis by clinical and radiologic findings alone. The aim of this study was to evaluate diagnostic and therapeutic benefits of invasive procedures for new lung infiltrates in leukemia. Methods : Patients with leukemia who developed new lung infiltrates from December 1994 to March 1999 were included in this study. These patients were classified into the empirical group who received empirical therapy only and into the invasive group who underwent bronchoscopy or surgical lung biopsy for the diagnostic purpose of new lung infiltrates. A retrospective chart review was done to find the etiologies of new lung infiltrates, the yield of invasive procedures, outcome as well as predicting factors for survival. Results : 1) One hundred-two episodes of new lung infiltrates developed in 90 patients with leukemia. Invasive procedures were performed in 44 episodes while 58 episodes were treated with empirical therapy only. 2) Invasive procedures yielded a specific diagnosis in 72.7%(32/44), of which 78.1% had infectious etiology. Therapeutic plan was changed in 52.3%(23/44) of patients after invasive procedures. None of them showed procedure-related mortality. 3) The overall survival rate was 62.7%(64/102). Survival rate in the invasive group (79.5%) was significantly better than that in the empirical group (50.0%) (p=0.002). 4) Upon multivariate analysis, the performance of invasive procedures, no need for mechanical ventilation and achievement of complete remission of leukemia after induction chemotherapy were the independent predicting factors for survival in patients with leukemia and new lung infiltrates. Conclusion : Bronchoscopy and surgical lung biopsy are useful in the diagnosis of new lung infiltrates in patients with leukemia. However, survival benefits of invasive procedures should be considered together with disease status of leukemia and severity of respiratory compromise.

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The Jurisdictional Precedent Analysis of Medical Dispute in Dental Field (치과임상영역에서 발생된 의료분쟁의 판례분석)

  • Kwon, Byung-Ki;Ahn, Hyoung-Joon;Kang, Jin-Kyu;Kim, Chong-Youl;Choi, Jong-Hoon
    • Journal of Oral Medicine and Pain
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    • v.31 no.4
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    • pp.283-296
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    • 2006
  • Along with the development of scientific technologies, health care has been growing remarkably, and as the social life quality improves with increasing interest in health, the demand for medical service is rapidly increasing. However, medical accident and medical dispute also are rapidly increasing due to various factors such as, increasing sense of people's right, lack of understanding in the nature of medical practice, over expectation on medical technique, commercialize medical supply system, moral degeneracy and unawareness of medical jurisprudence by doctors, widespread trend of mutual distrust, and lack of systematized device for solution of medical dispute. This study analysed 30 cases of civil suit in the year between 1994 to 2004, which were selected among the medical dispute cases in dental field with the judgement collected from organizations related to dentistry and department of oral medicine, Yonsei university dental hospital. The following results were drawn from the analyses: 1. The distribution of year showed rapid increase of medical dispute after the year 2000. 2. In the types of medical dispute, suit associated with tooth extraction took 36.7% of all. 3. As for the cause of medical dispute, uncomfortable feeling and dissatisfaction with the treatment showed 36.7%, death and permanent damage showed 16.7% each. 4. Winning the suit, compulsory mediation and recommendation for settlement took 60.0% of judgement result for the plaintiff. 5. For the type of medical organization in relation to medical dispute, 60.0% was found to be the private dental clinics, and 30.0% was university dental hospitals. 6. For the level of trial, dispute that progressed above 2 or 3 trials was of 30.0%. 7. For the amount of claim for damage, the claim amounting between 50 million to 100 million won was of 36.7%, and that of more than 100 million won was 13.3%, and in case of the judgement amount, the amount ranging from 10 million to 30 million won was of 40.0%, and that of more than 100 million won was of 6.7%. 8. For the number of dentist involved in the suit, 26.7% was of 2 or more dentists. 9. For the amount of time spent until the judgement, 46.7% took 11 to 20 months, and 36.7% took 21 to 30 months. 10. For medical malpractice, 46.7% was judged to be guilty, and 70% of the cases had undergone medical judgement or verification of the case by specialists during the process of the suit. 11. In the lost cases of doctors(18 cases), 72.2% was due to violence of carefulness in practice and 16.7% was due to missing of explanation to patient. Medical disputes occurring in the field of dentistry are usually of relatively less risky cases. Hence, the importance of explanation to patient is emphasized, and since the levels of patient satisfaction are subjective, improvement of the relationship between the patient and the dentist and recovery of autonomy within the group dentist are essential in addition to the reduction of technical malpractice. Moreover, management measure against the medical dispute should be set up through complement of the current doctors and hospitals medical malpractice insurance which is being conducted irrationally, and establishment of system in which education as well as consultation for medical disputes lead by the group of dental clinicians and academic scholars are accessible.

Comparison of Heart Rate Variability Indices between Obstructive Sleep Apnea Syndrome and Primary Insomnia (폐쇄성 수면무호흡 증후군과 일차성 불면증에서 심박동률 변이도 지수의 비교)

  • Nam, Ji-Won;Park, Doo-Heum;Yu, Jaehak;Ryu, Seung-Ho;Ha, Ji-Hyeon
    • Sleep Medicine and Psychophysiology
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    • v.19 no.2
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    • pp.68-76
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    • 2012
  • Objectives: Sleep disorders cause changes of autonomic nervous system (ANS) which affect cardiovascular system. Primary insomnia (PI) makes acceleration of sympathetic nervous system (SNS) tone by sleep deficiency and arousal. Obstructive sleep apnea syndrome (OSAS) sets off SNS by frequent arousals and hypoxemias during sleep. We aimed to compare the changes of heart rate variability (HRV) indices induced by insomnia or sleep apnea to analyze for ANS how much to be affected by PI or OSAS. Methods: Total 315 subjects carried out nocturnal polysomnography (NPSG) were categorized into 4 groups - PI, mild, moderate and severe OSAS. Severity of OSAS was determined by apnea-hypopnea index (AHI). Then we selected 110 subjects considering age, sex and valance of each group's size [Group 1 : PI (mean age=$41.50{\pm}13.16$ yrs, AHI <5, n=20), Group 2 : mild OSAS (mean age=$43.67{\pm}12.11$ yrs, AHI 5-15, n=30), Group 3 : moderate OSAS (mean age $44.93{\pm}12.38$ yrs, AHI 16-30, n=30), Group 4 : severe OSAS (mean age=$45.87{\pm}12.44$ yrs, AHI >30, n=30)]. Comparison of HRV indices among the four groups was performed with ANCOVA (adjusted for age and body mass index) and Sidak post-hoc test. Results: We found statistically significant differences in HRV indices between severe OSAS group and the other groups (PI, mild OSAS and moderate OSAS). And there were no significant differences in HRV indices among PI, mild and moderate OSAS group. In HRV indices of PI and severe OSAS group showing the most prominent difference in the group comparisons, average RR interval were $991.1{\pm}27.1$ and $875.8{\pm}22.0$ ms (p=0.016), standard deviation of NN interval (SDNN) was $85.4{\pm}6.6$ and $112.8{\pm}5.4$ ms (p=0.022), SDNN index was $57.5{\pm}5.2$ and $87.6{\pm}4.2$ (p<0.001), total power was $11,893.5{\pm}1,359.9$ and $18,097.0{\pm}1,107.2ms^2$(p=0.008), very low frequency (VLF) was $7,534.8{\pm}1,120.1$ and $11,883.8{\pm}912.0ms^2$ (p=0.035), low frequency (LF) was $2,724.2{\pm}327.8$ and $4,351.6{\pm}266.9ms^2$(p=0.003). Conclusions: VLF and LF which were correlated with SNS tone showed more increased differences between severe OSAS group and PI group than other group comparisons. We could suggest that severe OSAS group was more influential to increased SNS activity than PI group.

Differential Diagnosis By Analysis of Pleural Effusion (흉수분석에 의한 질병의 감별진단)

  • Ko, Won-Ki;Lee, Jun-Gu;Jung, Jae-Ho;Park, Mu-Suk;Jeong, Nak-Yeong;Kim, Young-Sam;Yang, Dong-Gyoo;Yoo, Nae-Choon;Ahn, Chul-Min;Kim, Sung-Kyu
    • Tuberculosis and Respiratory Diseases
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    • v.51 no.6
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    • pp.559-569
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    • 2001
  • Background : Pleural effusion is one of the most common clinical manifestations associated with a variety of pulmonary diseases such as malignancy, tuberculosis, and pneumonia. However, there are no useful laboratory tests to determine the specific cause of pleural effusion. Therefore, an attempt was made to analyze the various types of pleural effusion and search for useful laboratory tests for pleural effusion in order to differentiate between the diseases, especially between a malignant pleural effusion and a non-malignant pleural effusion. Methods : 93 patients with a pleural effusion, who visited the Severance hospital from January 1998 to August 1999, were enrolled in this study. Ultrasound-guided thoracentesis was done and a confirmational diagnosis was made by a gram stain, bacterial culture, Ziehl-Neelsen stain, a mycobacterial culture, a pleural biopsy and cytology. Results : The male to female ratio was 56 : 37 and the average age was $47.1{\pm}21.8$ years. There were 16 cases with a malignant effusion, 12 cases with a para-malignant effusion, 36 cases with tuberculosis, 22 cases with a para-pneumonic effusion, and 7 cases with transudate. The LDH2 fraction was significantly higher in the para-malignant effusion group compared to the para-pneumonic effusion group [$30.6{\pm}6.4%$ and $20.2{\pm}7.5%$, respectively (p<0.05)] and both the LDH1 and LDH2 fraction was significantly in the para-malignant effusion group compared to those with tuberculosis [$16.4{\pm}7.2%$ vs. $7.6{\pm}4.7%$, and $30.6{\pm}6.4%$ vs.$17.6{\pm}6.3%$, respectively (p<0.05)]. The pleural effusion/serum LDH4 fraction ratio was significantly lower in the malignant effusion group compared to those with tuberculosis [$1.5{\pm}0.8$ vs. $2.1{\pm}0.6$, respectively (p<0.05)]. The LDH4 fraction and the pleural effusion/serum LDH4 fraction ratio was significantly lower in the para-malignant effusion group compared to those with tuberculosis [$17.0{\pm}5.8%$ vs. $23.5{\pm}4.6%$ and $1.3{\pm}0.4$ vs. $2.1{\pm}0.6$, respectively (p<0.05)]. Conclusion : These results suggest that the LDH isoenzyme was the only useful biochemical test for a differential diagnosis of the various diseases. In particular, the most useful test was the pleural effusion/serum LDH4 fraction ratio to distinguish between a para-malignant effusion and a tuberculous effusion.

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An Analysis on the Conditions for Successful Economic Sanctions on North Korea : Focusing on the Maritime Aspects of Economic Sanctions (대북경제제재의 효과성과 미래 발전 방향에 대한 고찰: 해상대북제재를 중심으로)

  • Kim, Sang-Hoon
    • Strategy21
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    • s.46
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    • pp.239-276
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    • 2020
  • The failure of early economic sanctions aimed at hurting the overall economies of targeted states called for a more sophisticated design of economic sanctions. This paved way for the advent of 'smart sanctions,' which target the supporters of the regime instead of the public mass. Despite controversies over the effectiveness of economic sanctions as a coercive tool to change the behavior of a targeted state, the transformation from 'comprehensive sanctions' to 'smart sanctions' is gaining the status of a legitimate method to impose punishment on states that do not conform to international norms, the nonproliferation of weapons of mass destruction in this particular context of the paper. The five permanent members of the United Nations Security Council proved that it can come to an accord on imposing economic sanctions over adopting resolutions on waging military war with targeted states. The North Korean nuclear issue has been the biggest security threat to countries in the region, even for China out of fear that further developments of nuclear weapons in North Korea might lead to a 'domino-effect,' leading to nuclear proliferation in the Northeast Asia region. Economic sanctions had been adopted by the UNSC as early as 2006 after the first North Korean nuclear test and has continually strengthened sanctions measures at each stage of North Korean weapons development. While dubious of the effectiveness of early sanctions on North Korea, recent sanctions that limit North Korea's exports of coal and imports of oil seem to have an impact on the regime, inducing Kim Jong-un to commit to peaceful talks since 2018. The purpose of this paper is to add a variable to the factors determining the success of economic sanctions on North Korea: preventing North Korea's evasion efforts by conducting illegal transshipments at sea. I first analyze the cause of recent success in the economic sanctions that led Kim Jong-un to engage in talks and add the maritime element to the argument. There are three conditions for the success of the sanctions regime, and they are: (1) smart sanctions, targeting commodities and support groups (elites) vital to regime survival., (2) China's faithful participation in the sanctions regime, and finally, (3) preventing North Korea's maritime evasion efforts.

Muc5ac Gene Expression Induced by Cigarette Smoke is Mediated Via a Pathway Involving ERK1/2 and p38 MAPK (담배 연기에 의한 Muc5ac 유전자 발현에 관여하는 세포 내 신호 전달 경로로서의 ERK1/2와 p38 MAPK)

  • Kim, Yong Hyun;Yoon, Hyoung Kyu;Kim, Chi Hong;Ahn, Joong Hyun;Kwon, Soon Seog;Kim, Young Kyoon;Kim, Kwan Hyoung;Moon, Hwa Sik;Park, Sung Hak;Song, Jeong Sup;Cho, Kyung Sook
    • Tuberculosis and Respiratory Diseases
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    • v.58 no.6
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    • pp.590-599
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    • 2005
  • Object : Cigarette smoking is a major cause of mucus hypersecretion, which is a pathophysiological feature of many inflammatory airway diseases. Mucins, which are an important part of the airway mucus, are synthesized from the Muc gene in airway epithelial cells. However, the signaling pathways for cigarette smoke-induced mucin synthesis are unknown. The aim of this study was to determine the signal pathway for smoking induced Muc5ac gene expression. Methods : A549 cells were cultured and transiently transfected with the Muc5ac promoter fragment. These cells were stimulated with 5% cigarette smoke extract (CSE) alone or with CSE after a pretreatment with various signal transduction pathway inhibitors (AG1478, PD98059 and SB203580). The Muc5ac promoter activity was examined using the luciferase reporter system, and the level of phosphorylated EGFR, ERK1/2, p38 MAPK and JNK were all examined using Western blot analysis. Muc5ac mRNA expression was also examined using reverse transcriptase polymerase chain reactions (RT-PCR). Results : 1. The peak level of luciferase activity of the Muc5ac promoter was observed at 5% concentration and after 3 hours of incubation with the CSE. The level of EGFR phosphorylation and the luciferase activity of the transfected cells caused by the CSE were significantly suppressed by AG1478 or PD98059 (P<0.01). 2. CSE phosphorylated ERK1/2 or p38 MAPK but not JNK. The Muc5ac mRNA expression level was increased by the CSE but that was suppressed by PD98059 or AG1478. 3. The CSE-induced phosphorylation of ERK1/2 was blocked by PD98059 and that of p38 MAPK was blocked by either PD98059 or SB203580. Either PD98059 or SB203580 suppressed the luciferase activity of the transfected cells (P<0.0001). Conclusion : The Muc5ac mRNA expression level was increased by the CSE. The increased CSE-induced transcriptional activity was mediated via EGF receptor activation, which led to ERK1/2 and p38 MAPK phosphorylation.

Diagnostic Value of ADA Multiplied by Lymphocyte to Neutrophil Ratio in Tuberculous Pleurisy (결핵성 흉막염에서 ADA 활성도와 림프구/중성구 비의 곱의 진단적 유용성)

  • Jeon, Eun Ju;Kwak, Hee Won;Song, Ju Han;Lee, Young Woo;Jeong, Jae Woo;Choi, Jae Cheol;Shin, Jong Wook;Kim, Jae Yeol;Park, In Won;Choi, Byoung Whui
    • Tuberculosis and Respiratory Diseases
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    • v.63 no.1
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    • pp.17-23
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    • 2007
  • Background: Many diagnostic approaches for defining the definitive cause of pleurisy should be included due to the large variety of diseases resulting in pleural effusion. Although ADA is a useful diagnostic tool for making a differential diagnosis of pleural effusion, particularly for tuberculous pleural effusion, a definitive diagnostic cut-off value remains problematic in Korea. It was hypothesized that ADA multiplied by the Lymphocyte/Neutrophil ratio(L/N ratio) might be more powerful for making a differential diagnosis of pleural effusion. Methods: One hundred and ninety patients, who underwent thoracentesis and treatment in Chung-Ang University Hospital from January, 2005 through to February 2006, were evaluated. The clinical characteristics, radiologic data and the examination of the pleural effusion were analyzed retrospectively. Results: 1. Among the 190 patients, 59 patients (31.1%) were diagnosed with tuberculous pleurisy, 45 patients(23.7%) with parapneumonic effusion, 42 patients(22.1%) with malignant effusions, 36 patients(18.9%) with transudate, and 8 patients(4.2%) with empyema. One hundred and twenty one patients were found to have an ADA activity of 1 to 39 IU/L(63.7%). Twenty-nine were found to have an ADA activity of 40 to 75 IU/L(15.3%) and 40 were found to have an ADA activity of 75 IU/L or greater(21.0%). 2. Among the patients with tuberculous pleurisy, 5(8%), 18(30%) and 36 patients(60%) had an ADA activity ranging from 1 to 39 IU/L, 40 to 75 IU/L, and 75 IU/L or greater, respectively. In those with an ADA activitiy 40 to 75 IU/L, 18 patients(62%) had tuberculous pleurisy, 9(31%) had parapneumonic effusion and empyema, and 1(3.4%) had a malignant effusion. 3. In those with an ADA activity of 40 to 75 IU/L, there was no significant difference between tuberculous pleurisy and non-tuberculous pleural effusion(tuberculous pleurisy : 61.3 ${\pm}$ 9.2 IU/L, non-tuberculous pleural effusion : 53.3${\pm}$10.5 IU/L). 4. The mean L/N ratio of those with tuberculous pleurisy was 39.1 ${\pm}$ 44.6, which was significantly higher than nontuberculous pleural effusion patients (p<0.05). The mean ADA x L/N ratio of the tuberculous pleurisy patients was 2,445.7 ${\pm}$ 2,818.5, which was significantly higher than the non-tuberculous pleural effusion patients (level p<0.05). 5. ROC analysis showed that the ADA x L/N ratio had a higher diagnostic value than the ADA alone in the group with an ADA between 40-75 IU/L. Conclusion: The ADA multiplied by the lymphocyte-to-neutrophil ratio might provide a more definitive diagnosis of tuberculous pleurisy.

Analysis of HBeAg and HBV DNA Detection in Hepatitis B Patients Treated with Antiviral Therapy (항 바이러스 치료중인 B형 간염환자에서 HBeAg 및 HBV DNA 검출에 관한 분석)

  • Cheon, Jun Hong;Chae, Hong Ju;Park, Mi Sun;Lim, Soo Yeon;Yoo, Seon Hee;Lee, Sun Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.23 no.1
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    • pp.35-39
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    • 2019
  • Purpose Hepatitis B virus (hepatitis B virus, HBV) infection is a worldwide major public health problem and it is known as a major cause of chronic hepatitis, liver cirrhosis and liver cancer. And serologic tests of hepatitis B virus is essential for diagnosing and treating these diseases. In addition, with the development of molecular diagnostics, the detection of HBV DNA in serum diagnoses HBV infection and is recognized as an important indicator for the antiviral agent treatment response assessment. We performed HBeAg assay using Immunoradiometric assay (IRMA) and Chemiluminescent Microparticle Immunoassay (CMIA) in hepatitis B patients treated with antiviral agents. The detection rate of HBV DNA in serum was measured and compared by RT-PCR (Real Time - Polymerase Chain Reaction) method Materials and Methods HBeAg serum examination and HBV DNA quantification test were conducted on 270 hepatitis B patients undergoing anti-virus treatment after diagnosis of hepatitis B virus infection. Two serologic tests (IRMA, CMIA) with different detection principles were applied for the HBeAg serum test. Serum HBV DNA was quantitatively measured by real-time polymerase chain reaction (RT-PCR) using the Abbott m2000 System. Results The detection rate of HBeAg was 24.1% (65/270) for IRMA and 82.2% (222/270) for CMIA. Detection rate of serum HBV DNA by real-time RT-PCR is 29.3% (79/270). The measured amount of serum HBV DNA concentration is $4.8{\times}10^7{\pm}1.9{\times}10^8IU/mL$($mean{\pm}SD$). The minimum value is 16IU/mL, the maximum value is $1.0{\times}10^9IU/mL$, and the reference value for quantitative detection limit is 15IU/mL. The detection rates and concentrations of HBV DNA by group according to the results of HBeAg serological (IRMA, CMIA)tests were as follows. 1) Group I (IRMA negative, CMIA positive, N = 169), HBV DNA detection rate of 17.7% (30/169), $6.8{\times}10^5{\pm}1.9{\times}10^6IU/mL$ 2) Group II (IRMA positive, CMIA positive, N = 53), HBV DNA detection rate 62.3% (33/53), $1.1{\times}10^8{\pm}2.8{\times}10^8IU/mL$ 3) Group III (IRMA negative, CMIA negative, N = 36), HBV DNA detection rate 36.1% (13/36), $3.0{\times}10^5{\pm}1.1{\times}10^6IU/mL$ 4) Group IV(IRMA positive, CMIA negative, N = 12), HBV DNA detection rate 25% (3/12), $1.3{\times}10^3{\pm}1.1{\times}10^3IU/mL$ Conclusion HBeAg detection rate according to the serological test showed a large difference. This difference is considered for a number of reasons such as characteristics of the Ab used for assay kit and epitope, HBV of genotype. Detection rate and the concentration of the group-specific HBV DNA classified serologic results confirmed the high detection rate and the concentration in Group II (IRMA-positive, CMIA positive, N = 53).

The Effects of Switching-Frustrated Situation on Negative Psychological Response (전환 좌절상황에서 소비자의 부정적 심리반응에 관한 연구)

  • Jeong, Yun Hee
    • Asia Marketing Journal
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    • v.14 no.1
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    • pp.131-157
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    • 2012
  • Despite the voluminous research on switching barriers, the notion that they can generate negative responses has not been investigated. Further, a critical question is what determines the strength of such negative responses. To address this question, the classic theory of psychological reactance is briefly reviewed, and the idea of switching barrier is advanced. This study attempts to suggest a model on the negative effects of switching- frustrated situation, based on the studies on psychological reactance. According to psychological reactance theory(Brehm 1966), whenever a freedom is threatened or removed, individuals are motivated, at least temporarily, to restore their freedom. For example, if individuals think they are free to engage in behaviors .v, y, or z, then threatening their freedom to engage in x would cause psychological reactance. This reactance could be reduced by an increase in the perceived attractiveness of engaging in, the threatened behavior(Kivetz 2005). This investigation seeks to extend existing switching barrier research in three important ways. First, while the past research has emphasized only positive role of switching barrier, this study address negative role of it by applying psychological reactance theory. Second, to find negative results of switching barrier, I suggest negative psychological response including regret to the past choice, resentment to the present provider, and strong desire to the alternative provider. Third, I suggest the perceived severity of the switching barriers, the attractiveness of the alternative as switching-frustrated situation which can lead to negative results. And, in addition to these relationships, I added moderated effects of perceived justice for better explanation. So this study includes the following hypotheses. H1-1 ~ H1-3: The attractiveness of the alternative has a positive effect regret to the past choice (h1-1), resentment to the present provider (h1-2), and strong desire to the alternative provider (h1-3). H2-1 ~ H2-3 : The perceived severity of the switching barrier has a positive effect regret to the past choice (h2-1), resentment to the present provider (h2-2), and strong desire to the alternative provider (h2-3). H3-1 ~ H3-3 : The positive relationships between the attractiveness of the alternative and consumer' negative responses will be stronger at low level of perceived justice than at high level of perceived justice. H4-1 ~ H4-3 : The positive relationships between the perceived severity of the switching barrier and consumer' negative responses will be stronger at low level of perceived justice than at high level of perceived justice. Survey research is employed to test hypotheses involving perceived severity of the switching barrier(Hess 2008), attractiveness of the alternative(Anderson and Narus 1990; Ohanian 1990),regret(Glovich and Medvec 1995), resentment, strong desire(Alcohol Urge Questionaire: Bohn et al. 1995), perceived justice(Bies and Moag 1986; Clemmer 1993; Lind and Tyler 1998). Previous researches, such as reactance theory, emotion and service failure, have been referenced to measure constructs. All items were measured on a 7-point Likert scale ranging from "strongly disagree" to "strongly agree". We collected data involving various service field, and used 249 respondents to analyze these data using the moderated regression. The results of our analysis suggest, as expected, that the perceived severity of the switching barrier had positive effects on regret to the past choice(b = .197, p< .01), resentment to the present provider(b = .214, p< .01), and strong desire to the alternative provider(b = .254, p< .001). And the attractiveness of the alternative had positive effects on regret to the past choice(b = .353, p<.001), resentment to the present provider(b = .174, p< .01), and strong desire to the alternative provider(b = .265, p< .001). However, our findings indicate perceived justice partly moderates relationship between switching-frustrated situation and psychological negative response. The study has brought to light a number of insights between switching barriers and consumer' negative responses that have been subject to little prior research. In particular, this study adds to the existing understanding of the psychological responses to switching barriers in switching- frustrated situation. This research therefore has significance to marketers for strategic marketing programs, particularly in terms of customer retention and switching barrier strategies. Since consumers could exhibit negative responses to switching barrier, companies would be able to lose their customer when they thoughtlessly use switching barrier for remaining customer. Although the study has these contributions, there are several limitations including unsupported hypotheses and research method. So, we need to make up for these limitations in the future researches.

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The Effect of Price Discount Rate According to Brand Loyalty on Consumer's Acquisition Value and Transaction Value (브랜드애호도에 따른 가격할인율의 차이가 소비자의 획득가치와 거래가치에 미치는 영향)

  • Kim, Young-Ei;Kim, Jae-Yeong;Shin, Chang-Nag
    • Journal of Global Scholars of Marketing Science
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    • v.17 no.4
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    • pp.247-269
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    • 2007
  • In recent years, one of the major reasons for the fierce competition amongst firms is that they strive to increase their own market shares and customer acquisition rate in the same market with similar and apparently undifferentiated products in terms of quality and perceived benefit. Because of this change in recent marketing environment, the differentiated after-sales service and diversified promotion strategies have become more important to gain competitive advantage. Price promotion is the favorite strategy that most retailers use to achieve short-term sales increase, induce consumer's brand switch, in troduce new product into market, and so forth. However, if marketers apply or copy an identical price promotion strategy without considering the characteristic differences in product and consumer preference, it will cause serious problems because discounted price itself could make people skeptical about product quality, and the changes of perceived value might appear differently depending on other factors such as consumer involvement or brand attitude. Previous studies showed that price promotion would certainly increase sales, and the discounted price compared to regular price would enhance the consumer's perceived values. On the other hand, discounted price itself could make people depreciate or skeptical about product quality, and reduce the consumers' positivity bias because consumers might be unsure whether the current price promotion is the retailer's best price offer. Moreover, we cannot say that discounted price absolutely enhances the consumer's perceived values regardless of product category and purchase situations. That is, the factors that affect consumers' value perceptions and buying behavior are so diverse in reality that the results of studies on the same dependent variable come out differently depending on what variable was used or how experiment conditions were designed. Majority of previous researches on the effect of price-comparison advertising have used consumers' buying behavior as dependent variable. In order to figure out consumers' buying behavior theoretically, analysis of value perceptions which influence buying intentions is needed. In addition, they did not combined the independent variables such as brand loyalty and price discount rate together. For this reason, this paper tried to examine the moderating effect of brand loyalty on relationship between the different levels of discounting rate and buyers' value perception. And we provided with theoretical and managerial implications that marketers need to consider such variables as product attributes, brand loyalty, and consumer involvement at the same time, and then establish a differentiated pricing strategy case by case in order to enhance consumer's perceived values properl. Three research concepts were used in our study and each concept based on past researches was defined. The perceived acquisition value in this study was defined as the perceived net gains associated with the products or services acquired. That is, the perceived acquisition value of the product will be positively influenced by the benefits buyers believe they are getting by acquiring and using the product, and negatively influenced by the money given up to acquire the product. And the perceived transaction value was defined as the perception of psychological satisfaction or pleasure obtained from taking advantage of the financial terms of the price deal. Lastly, the brand loyalty was defined as favorable attitude towards a purchased product. Thus, a consumer loyal to a brand has an emotional attachment to the brand or firm. Repeat purchasers continue to buy the same brand even though they do not have an emotional attachment to it. We assumed that if the degree of brand loyalty is high, the perceived acquisition value and the perceived transaction value will increase when higher discount rate is provided. But we found that there are no significant differences in values between two different discount rates as a result of empirical analysis. It means that price reduction did not affect consumer's brand choice significantly because the perceived sacrifice decreased only a little, and customers are satisfied with product's benefits when brand loyalty is high. From the result, we confirmed that consumers with high degree of brand loyalty to a specific product are less sensitive to price change. Thus, using price promotion strategy to merely expect sale increase is not recommendable. Instead of discounting price, marketers need to strengthen consumers' brand loyalty and maintain the skimming strategy. On the contrary, when the degree of brand loyalty is low, the perceived acquisition value and the perceived transaction value decreased significantly when higher discount rate is provided. Generally brands that are considered inferior might be able to draw attention away from the quality of the product by making consumers focus more on the sacrifice component of price. But considering the fact that consumers with low degree of brand loyalty are known to be unsatisfied with product's benefits and have relatively negative brand attitude, bigger price reduction offered in experiment condition of this paper made consumers depreciate product's quality and benefit more and more, and consumer's psychological perceived sacrifice increased while perceived values decreased accordingly. We infer that, in the case of inferior brand, a drastic price-cut or frequent price promotion may increase consumers' uncertainty about overall components of product. Therefore, it appears that reinforcing the augmented product such as after-sale service, delivery and giving credit which is one of the levels consisting of product would be more effective in reality. This will be better rather than competing with product that holds high brand loyalty by reducing sale price. Although this study tried to examine the moderating effect of brand loyalty on relationship between the different levels of discounting rate and buyers' value perception, there are several limitations. This study was conducted in controlled conditions where the high involvement product and two different levels of discount rate were applied. Given the presence of low involvement product, when both pieces of information are available, it is likely that the results we have reported here may have been different. Thus, this research results explain only the specific situation. Second, the sample selected in this study was university students in their twenties, so we cannot say that the results are firmly effective to all generations. Future research that manipulates the level of discount along with the consumer involvement might lead to a more robust understanding of the effects various discount rate. And, we used a cellular phone as a product stimulus, so it would be very interesting to analyze the result when the product stimulus is an intangible product such as service. It could be also valuable to analyze whether the change of perceived value affects consumers' final buying behavior positively or negatively.

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